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Use of a Colorimetric Carbon Dioxide Sensor for Nasoenteric Feeding Tube Placement in Critical Care Patients Compared With Clinical Methods and Radiography

From ¹ Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;² State University of New York—SUNY, Downstate Medical Center, Brooklyn, New York; ³ Unit Director Intravenous Therapy and Enteral Access Team, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; ⁴ Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, Brazil; and⁵ School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.

Address correspondence to: Juan B. Ochoa, MD, FACS, Department of Surgery, University of Pittsburgh, Lothrop Street, Pittsburgh, PA 15213; e-mail: ochoajb{at}upmc.edu.

Background: Misplacement of nasoenteric feeding tubes (NFTs) into the airway instead of the esophagus leads to complications. Healthcare providers have relied on clinical methods, devices such as carbon dioxide (CO₂) sensors, and radiography (the gold standard) to evaluate NFT placements. Most institutions include radiographs in their protocols for NFT insertions, making it expensive and cumbersome. A new commercial CO₂ sensor was developed to assist in these procedures, and the authors evaluated its use. Methods: Nurses performing NFT placement completed questionnaires following each procedure. The nurses recorded the clinical methods used to determine proper insertion and, based on them, where the NFT was located. Nurses then evaluated NFT insertion with the CO₂ sensor; from the readings, they recorded where the tube was located. Confirmation of tube placement was performed radiographically. Results: The authors evaluated 424 NFT insertions. Of these, 15 (3.5%) were incorrectly placed into the airway, and 409 were correctly placed into the esophagus. The CO₂ sensor correctly assessed NFT placement in 421 (99%) of the 424 cases. The authors found the device to have a sensitivity of 86.7% and a specificity of 99.8%. Conclusions: The CO₂ sensor is a helpful bedside tool to use in conjunction with clinical methods during NFT insertions. However, there is insufficient evidence to abandon the use of radiographs to confirm tube placement.

Key Words: carbon dioxide • gastrointestinal intubation • enteral nutrition • critical care

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